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RENEWAL Regional Workshop 2010, Cape Town Food Security and Nutrition among People Living with HIV in Uganda: Emerging Results from the IFPRI/RENEWAL-TASO  Collaboration ----------------------------------------------------------------------------------------------------- Suneetha Kadiyala   &  Rahul Rawat
Food insecurity and HIV: What do we know?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Weiser SD et al 2009; Normen L et al 2005; Weiser SD et al 2008 and other sources RISK IMPACT HIV AIDS Prevention Care & Treatment Mitigation
Rationale for Nutrition Programs ,[object Object],[object Object],[object Object],[object Object],[object Object],Source: Zachariah et al (AIDS 2006); Johannessen et al. (BMC Infectious Disease 2008); Koethe et al. (JAIDS 2010)
Nutrition Program Responses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Food Insecurity, Undernutrition and HIV: 3 key  questions ,[object Object],[object Object],[object Object],[object Object],[object Object]
3 Key Components (2007-2010) ,[object Object],[object Object],[object Object]
Study 1: Food Effectiveness Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Outcomes of Interest in Programs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Emerging Results ,[object Object],[object Object],[object Object],[object Object],[object Object]
Determinants of Undernutrition ,[object Object],[object Object],HH Food Insecurity Individual Dietary Diversity Mean BMI values adjusted for CD4 count, sex, HH expenditure, HH asset value district, HH size, education Δ =0.45 kg/m 2 ; p = 0.031 Δ =0.90 kg/m 2 ; p = 0.001 Δ =0.63 kg/m 2 ; p = 0.001
Determinants of Undernutrition ,[object Object],[object Object]
Evaluating Pathways to Undernutrition:  Path Analysis Notes: Numbers in parentheses are standard errors. For both Path 1 (Dietary Diversity) and Path 2 (BMI), the model is adjusted for all variables included in regression models presented in Tables 2 and 3. *p<0.05; ** p<0.01 Path and Dependent Outcome Predictor Vairable Direct Effect Indirect Effect Total Effect Path 1: Dietary Diversity Food Insecurity -0.043** (0.011) Path 2: BMI (kg/m 2 ) Dietary Diversity Food Insecurity 0.139* (0.056) -0.062** (0.019) -0.006* (0.057) -0.068* (0.060)
Nutritional Determinants of Disease Severity ,[object Object],[object Object],Model adjusted for age, sex, district, HH expenditure, HH asset value district, HH size, education Category Odds Ratio (p value) Severe HH Food Insecurity 0.95 (0.754) Nutrient Rich Foods  (ASF, MN rich fruits and vegetables) 0.84 (0.019) Cereals and Starches 1.16 (0.280) Fats and Oils 1.11 (0.304)
Study 2: Retrospective Evaluation of the TASO database ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Source: Rawat et al. (BMC Public Health 2010)
Impact of Food Assistance on Weight Gain ** significant at 1% ; *significant at 5% ; + significant at 10% a  Absolute value of t-statistics on ATT, in parentheses, are based on bootstrapped standard errors Source: Rawat et al. (BMC Public Health 2010) Change in Weight (kg) Food assistance Recipients (n) Matched Controls (n) ATT  a (absolute value of t-statistic) Overall 3202 11069 0.36 (3.19)** Conditional estimates Without ART 2783 9661 0.48 (2.14)* With ART 546 1120 0.17 (1.5) Baseline WHO stage 1 327 1479 -0.2 (0.55) Baseline WHO stage 2 2329 7318 0.26 (2.3)* Baseline WHO stage 3 615 1807 0.2 (1.8) + Baseline WHO stage 4 58 129 1.9 (1.9) +
Impact of Food Assistance on Weight Gain ** significant at 1% ; *significant at 5% ; + significant at 10% a  Absolute value of t-statistics on ATT, in parentheses, are based on bootstrapped standard errors Source: Rawat et al. (BMC Public Health 2010) Change in Weight (kg) Food assistance Recipients (n) Matched Controls (n) ATT  a (absolute value of t-statistic) Overall 3202 11069 0.36 (3.19)** Conditional estimates Without ART 2783 9661 0.48 (2.14)* With ART 546 1120 0.17 (1.5) Baseline WHO stage 1 327 1479 -0.2 (0.55) Baseline WHO stage 2 2329 7318 0.26 (2.3)* Baseline WHO stage 3 615 1807 0.2 (1.8) + Baseline WHO stage 4 58 129 1.9 (1.9) +
Preliminary Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Looking Ahead: Knowledge Gaps to Improve Programs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Key Publications (2007-date) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Food and nutrition assistance to PLHIV

  • 1. RENEWAL Regional Workshop 2010, Cape Town Food Security and Nutrition among People Living with HIV in Uganda: Emerging Results from the IFPRI/RENEWAL-TASO Collaboration ----------------------------------------------------------------------------------------------------- Suneetha Kadiyala & Rahul Rawat
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  • 12. Evaluating Pathways to Undernutrition: Path Analysis Notes: Numbers in parentheses are standard errors. For both Path 1 (Dietary Diversity) and Path 2 (BMI), the model is adjusted for all variables included in regression models presented in Tables 2 and 3. *p<0.05; ** p<0.01 Path and Dependent Outcome Predictor Vairable Direct Effect Indirect Effect Total Effect Path 1: Dietary Diversity Food Insecurity -0.043** (0.011) Path 2: BMI (kg/m 2 ) Dietary Diversity Food Insecurity 0.139* (0.056) -0.062** (0.019) -0.006* (0.057) -0.068* (0.060)
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  • 15. Impact of Food Assistance on Weight Gain ** significant at 1% ; *significant at 5% ; + significant at 10% a Absolute value of t-statistics on ATT, in parentheses, are based on bootstrapped standard errors Source: Rawat et al. (BMC Public Health 2010) Change in Weight (kg) Food assistance Recipients (n) Matched Controls (n) ATT a (absolute value of t-statistic) Overall 3202 11069 0.36 (3.19)** Conditional estimates Without ART 2783 9661 0.48 (2.14)* With ART 546 1120 0.17 (1.5) Baseline WHO stage 1 327 1479 -0.2 (0.55) Baseline WHO stage 2 2329 7318 0.26 (2.3)* Baseline WHO stage 3 615 1807 0.2 (1.8) + Baseline WHO stage 4 58 129 1.9 (1.9) +
  • 16. Impact of Food Assistance on Weight Gain ** significant at 1% ; *significant at 5% ; + significant at 10% a Absolute value of t-statistics on ATT, in parentheses, are based on bootstrapped standard errors Source: Rawat et al. (BMC Public Health 2010) Change in Weight (kg) Food assistance Recipients (n) Matched Controls (n) ATT a (absolute value of t-statistic) Overall 3202 11069 0.36 (3.19)** Conditional estimates Without ART 2783 9661 0.48 (2.14)* With ART 546 1120 0.17 (1.5) Baseline WHO stage 1 327 1479 -0.2 (0.55) Baseline WHO stage 2 2329 7318 0.26 (2.3)* Baseline WHO stage 3 615 1807 0.2 (1.8) + Baseline WHO stage 4 58 129 1.9 (1.9) +
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Notas do Editor

  1. The indirect effect of food insecurity on BMI, mediated through dietary diversity is negligible, and almost entirely a result of the direct effect of food insecurity on BMI